Nail guide for X-ray fracture table



Dec. 31 1940. E. W.CLEARY 2,226,708

NAIL GUIDE FOR X-RAY FRACTURE TABLE Filed Sept. 24, 1938 2 Sheets-Sheet 1 FIG. I.

FIG. IO.

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' ERNEST W. CLEARY ATTORNEY Dec. 31, 1940. E w CLEARY 2,226,708

NAIL GUIDE FOR X-RAY FRACTURE TABLE Filed Sept. 24, 1938 2 Sheets-Sheet 2 56 56 F IG. 4. E i 1* e INVENTOR ERNEST w CLEARY ATTORNEY 15 Another object is to support and direct the drill Fig, '7 is a horizontal section of the standard 15 Patented Dec. 31, 1940 t I UNITED STATES PATENT QFFICE NAIL GUIDE FOR X-RAY FRACTURE TABLE Ernest W. Cleary, San Francisco, Calif. Application September 24, 1938, Serial No. 231,542

1 Claim. (01. 128-83) This invention relates to improvements in nail Fig. 1 is a plan view from above of an accessory guide for X-ray fracture table, and, more partable constructed in accordance with this inven-' ticularly, to an accessory table for enabling action. curate fixation of fractured femoral necks and Fig. 2 is a side elevation of the same.

the method of using the same. Fig. 3 is an enlarged front elevation of the The subject matter of the present invention drill-holding transit which is adjustable in accomprises improvements over Patent #2,1l5,096, cordance with the coordinate background of X- issued to me April 26, 1938, and entitled "Surgical ray photographs. apparatus. Fig. 4 is a side elevation partially in'section of Among the objects of the present invention is the same. to operatively position a drill fordrilling the frac- Fig. 5 is a longitudinal section of the quick coutured femur in accordance with linear and direcpling bracket for supporting the leg rest. tional coordinates forming the background of Fig. 6 is a fragmentary horizontal section of X-ray photographs of the fracture. the same taken along the line VIVI in Fig. 5.

throughout the drilling operation and to obviate for supporting the leg rest and the sanitary the task of manually maintaining the drill in the guard enclosing the same.

desired position during the drilling operation. Fig. 8 is a front elevation in reduced scale of Another object is to assure the accuracy of the the photographic plate holder for the vertical drilling operation. plane. 20

Anothervobject is to render the non-permeable Fig. 9 is a transverse section showing construclines, which give rise to the coordinate backtion of one of the non-permeable lines for formground on the X-ray photographs, visible to the ing the coordinate background of the X-ray surgeon for use as datum lines to enable the photographs.

patient to be placed in a standardized position Fig. 10 is a schematic diagram of an X-ray 25 and posture on the table. This permits a series of photograph made in accordance with this inven- X-ray photographs to be made over a period of tion. weeks, months, or years under identical condi- When the femur neck is fractured, it is difiicult tions to facilitate an accurate determination of to hold the parts together without a positive any change or distortion which may have taken method of fixation. Several methods are used in 30 place during the time of such observation. practice, such as the Morrison lock bolt, the

Another object is to enable symmetrical posi- Smith-Peterson nail, the Moores multiple nails. tioning of the opposite sides of the patients body In order to apply any of these devices, it is necwith respect to the coordinate system of the essary that the femur be drilled to guide or rep table, thus making possible the taking of X-ray ceive the bolt or nail. As the. femur is deeply set photographs of similar presentations of the skelein the muscles of the body, it is exceedingly difiital structure on opposite sides of the body. X- cult to determine the proper point of entry of the rays so taken afford a means for disclosing any drill and the direction in which the bone should symmetrical or asymmetrical distortion of the be drilled.

40 photographed structure. Under the teaching of my previous patent,

Another object is to facilitate sterilization of above cited, X-r y P p s W a ba k- 40 the operating field. ground of linear and directional coordinates Another object is to simplify and decrease the were taken. These coordinates were utilized to cost of manufacture of such an apparatus. set a guide to be used as a visual aid in manually Another object is to render the apparatus more drilling the bone. 45 readily portable. The present invention provides a transit which Other objects and advantages appear as this is adjustable with respect to each of the several description progresses. coordinate axes and directional planes to provide In this specification and the accompanying a positive guide for p ng and directing he drawings, the invention is described in its predrill throughout the d ng operation. The sur- 50 ferred form. It is to be understood, however, geon is thus relieved of the task of visually posithat it may be embodied in other forms without tioning and manually holding the drill in aligndeparting from the spirit of the invention as dement with an index guide. The present dri1lfined in the claim following the description. holding transit further increases the accuracy of 255 In the two sheets of drawings: the drilling operation.

In detail, the construction illustrated in the drawings, referring more particularly to Figs. 1 and 2, comprises the base plates l and 2 which are hinged together at 3 for conveniently folding up the table for carrying, The top panels 4 and 5 are spaced from the base plates I and 2 by the blocks 1, 8, and 9 to form a hollow table which may be placed on any suitable support such as an ordinary operating table.

The standard II] is engageable in holes such as H in the block 9 on opposite sides of the table. The lower end of the standard is provided with a transverse pin (not shown) which is adapted to enter the notches l2 in the holes H to prevent rotation of the standard. The threaded stem I3 telescopes within the standard [0 and extends upwardly therefrom.

The hand wheel I4 is threaded 0n the stem l3 j and is supported on the standard l0. Rotation of the hand Wheel l4 will raise or lower the stem l3 with respect to the standard ID. The lock bolt I5 is arranged to lock the stem I3 in adjusted position. This adjusting means l4--|5 is conventional and is shown in detail in my previous patent hereinbefore referred to.

The bracket I6 is screwed on the top of the stem l3 and has the leg rest I! mounted thereon. The leg rest is suitably shaped to support the leg of the patient lying on the table. It may be suitably lined with soft rubber as indicated at H3 in Fig. 1. The meridian flange 19 on the rest H has the depending studs 20 and 20', see Figs. 5 and. 6, which are arranged to enter holes provided therefor in the bracket I6. The stud 20 has the encircling channel 2! therein which is adapted to be entered by the pawl 22 to prevent accidental removal of the rest I! from the bracket 16. The pawl 22 is attached to the fiat spring 23 which has one end fixed to the bracket I6. The plunger 24 extends through the bracket 16 and engages the opposite end of the spring 23 and is arranged to displace the pawl 22 from the channel 2| to permit the rest I! to be lifted off the bracket IS.

The top of the panel 5, which is of X-ray permeable material, has thereon the two symmetrical grids of rectangular coordinate lines 25 and the radial lines 26. These grids serve as backgrounds in the X-ray photography of the left and right buttocks respectively, as later described. The lines are formed by filling kerfs such as 21, see Fig. 9, in the panel 5 with plastic material 28 which is non-permeable to X-rays, such as red lead. The photographic plates enclosed in the usual holders are inserted beneath the pattern of lines 25-26 in the space between the base plate 2 and the top panel 5.

For photographing in the vertical plane, the cassette tunnel 29 is provided, see Figs. 2 and 8, which has the grid of rectangular and polar coordinate lines 36 inscribed thereon which are analogous to the lines 25, 26 above described. The cassette tunnel 30 is adapted to be removably mounted on the panel 5 adjacent the standard H) as shown in dotted lines in Fig. 2 by means not shown.

The usual Lisholm grids, well known in the technique of X-ray photography, may be used in conjunction with the photographic plate holders to increase the sharpness and intensify the images.

The drill holding transit has the base plate 3| which is arranged to be fastened to either side of the table panel 5 by the fingers 32, 32 which engage under the edge of the panel 5. The pins 33 project downwardly from the base 31 into holes such as 34 in the panel 5 to prevent lateral displacement of the base. The base plate is readily removed by grasping th finger lugs 35, lifting the pins 33 from the holes 34, and then sliding the plate outwardly, thus disengaging the fingers 32 from the edges of the panel 5.

The inner margin of the plate 31 is bent upward and angularly backward as at 36 to safeguard the operating field from possible contamination by expelled bowel content.

The transit slid 31 is confined beneath the guides 38, 39 and is longitudinally movable with respect to the leg rest IT. The guides have the graduations 40 parallel to the transverse lines 25 inscribed on the panel 5. The slide 31 has an index mark 31' cooperating with the graduations 40 whereby the slide may be appropriately adjusted with respect to the fractured femur as indicated by the coordinate background of the X-ray picture, see Fig. 10. The slide has the thumb screw 4| which may be manipulated to frictionally engage the base plate 3| tolock the slide in adjusted position. i

The hollow square standard 42 is fixed on the slide 31 and extends upwardly therefrom and has the post 43 telescoping therein. The post has the graduations 44 thereon which are spaced to correspond with the coordinate lines 30 on the panel 29. The post 43 is raised or lowered to bring the appropriate graduation 44 into registry with the top edge of the standard 42 and locked in adjusted position by the thumb screw 45.

The quadrant 46, see more particularly Figs. 3 and 4, is pivoted at 41 on the post 43 and has the circumferential angular graduations 48 which cooperate with the index line 49 on the post 43. The thumb screw 50 passing through the arcuate slot 5| in the quadrant 46 and engaging the post 43 is adapted to lock the quadrant in adjusted position.

The top of the quadrant 46 is bent to form the horizontal portion 52 upon which the circular base 53 is fixed. The disk 54 is concentrically pivoted on the base 53 by the bolt 55 and has the hollow drillguide 5656 mounted thereon.

The guide 56 is adapted to receive the standard drill 51 employed for drilling the femur neck for the Morrison lock bolt. It will be obvious to those skilled in the art that a suitable sleeve can beinserted in the guide 56 to accommodate the smaller diameter wire drills employed in other types of fixation.

The index lug 58 is fixed beneath the base 53 and is bent to overlie the disk 54. Suitable angulargraduations such as 59, see Fig. 1, are provided on the disk 54 to register with the lug 58 to indicate the directional position of the disk. The thumb screw 60 is threaded in the lug 58 and is adapted to engage and lock the disk 54 against rotation. v

For further protection of the operative field, the standard I6 is provided with a sanitary guard consisting of the two semi-cylindrical shells GI, 62, which are pivoted together by the hinges 63. The pintles 64 of these hinges are bent laterally to engage the shells 66, BI and are of resilient material to serve as springs to maintain the guard closed. The finger lugs 65, 66 are fixed to the shells GI, 62 and are adapted to be manually operated to swing the shells away from each other on their hinges 63 to permit placement and removal of the sanitary guard around the standard The method of using the present apparatus is as follows: The patient, suitably anaesthetised, is placed on the table panels 4-5, lying upon his back. The fracture is then reduced by any of the accepted methods. complished, the leg is placed with the knee flexed on the leg rest IT, and traction applied by elevating the rest I! by means of the hand wheel i l to slightly lift the buttock from the table. The hand wheel is then locked by means of the lock bolt l5. The hip is in a condition of internal rotation, that is, with the flexed lower leg forming an angle of about twenty degrees with the long axis of the torso.

In photographing the aiiected region in the horizontal plane, the X-ray tube (not shown) is set above the pelvis and somewhat to the outside of the fractured hip. The X-ray tube is directed by a suitable non-permeable sighting ring which may be similar to that disclosed in my previous patent, above referred to. The parts to be photographed will thus occupy a definite position with respect to the grid of coordinate lines 25, 26. The photographic plate is placed in the space between the pane1 5 and the base plate 2 and exposed to the X-ray emanations. When the film is developed, the shadows cast by the sighting ring and the coordinate lines 25, 26 will in dicate the relative position of the tube at the moment of exposure and the horizontal position of the femur on the table. The lines 26 aid in determining the angle of the axis of the neck of the femur when manually adjusted into proper relation to its head and the hip socket, in determining the proper angle for direction of the drill 51, see Fig. 10.

A second X-ray picture is similarly taken in the vertical plane with a photographic plate in the cassette tunnel 29. When the film is developed, the relation between the shadows of the sighting ring, the femur, and the coordinate grid 30 determine the position of the fractured parts with respect to the table.

When the photographs have been developed, the patient is replaced on the table in substan tially the sameposition that he was in when the pictures were taken as described, this is determined by fluoroscopic examination and comparison with the pictures. The sterilized base plate 3| is then slipped underneath the injured buttock and is held in place by the pins 33 and the fingers 32, as hereinbefore described. The slide 31 is then adjusted with respect to the When reduction is acgraduations 40 and held in place by tightening the thumb screw 4!. The positioning of the slide 3! with respect to the graduations it will depend upon the conjunction of the shadows of the horizontal coordinate lines 25 with the axis of the femur which determines the point to enter the drill. The post 43 is similarly adjusted with respect to the standard 32 in accordance with the linear coordinate reading of the desired drill entry point in the vertical plane.

The appropriate direction in the vertical plane in which the femur is to be drilled is quantitatively indicated by the polar coordinate lines in the shadow pattern cast by the grid 3%. The quadrant 46 is then adjusted in accordance with this polar coordinate reading by means of the corresponding'graduations 48 and is locked in position by the thumb screw 50. The rotatable disk 54 is similarly adjusted with respect to the index lug 58 in accordance with the polar coordinate lines in the photograph in the horizontal plane.

The drill 51 is now inserted in the guide 56 and the femur drilled to the required depth. This depth may be determined by study of the X-ray photographs. The desired type of fixation may be then applied.

While it is preferred to employ X-ray photography in carrying out the present method, it will be obvious to those skilled that an X-ray fluoroscope could be used if desired.

Having thus described this invention, What I claim and desire to secure by Letters Patent is:

An orthopedic apparatus in the class described including a horizontal table; a linear and polar coordinate grid that is non-permeable to X-rays, arranged horizontally on said table; a second grid with similar characteristic markings, and arranged vertically on said table in relation to said horizontal grid; means for holding a fractured limb in fixed relation to said horizontal and vertical grids; a horizontal base plate fixed on said table; a transit slide horizontally adjustable on said plate and having graduations thereon related to the lines on said grids; a vertically adjustable post on said slide; a drill holder on said post and having graduations thereon; and means for varying the position of said drill holder and the graduations thereon relative to the lines on said grids.

ERNEST W. CLEARY. 

